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wManerDiobtem <br />AUb*dr S6M 1MF2 <br />7,72-0711 9 Billings, MT 801-735-4489 + Casper, WY 088-235-0513 <br />15 • Rapid CO, SD 886-672-1225 - College Staft, TX 881490-2215 <br />Workorder Receipt Checklist <br />Cotter Corporation <br />Login completed by: Halley Ackerman <br />Reviewed by: BL2000\cwagner <br />Reviewed Date: 2/18/2011 <br />Shipping container/cooler in good condition? <br />Custody seals intact on shipping container/cooler? <br />Custody seals intact on sample bottles? <br />Chain of custody present? <br />Chain of custody signed when relinquished and received? <br />Chain of custody agrees with sample labels? <br />Samples in proper container/bottle? <br />Sample containers intact? <br />Sufficient sample volume for indicated test? <br />All samples received within holding time? <br />Container/Temp Blank temperature: <br />Water - VOA vials have zero headspace? <br />Water - pH acceptable upon receipt? <br />Contact and Corrective Action Comments: <br />None <br />IIIII?VII9lallnll <br />„azas54 <br />Date Received: 2/18/2011 <br />Received by: ha <br />Carrier name: FedEx <br />Yes No ? Not Present ? <br />Yes ? No ? Not Present Q <br />Yes ? No ? Not Present Q <br />Yes Q No ? <br />Yes No ? <br />Yes No ? <br />Yes No ? <br />Yes Q No ? <br />Yes No ? <br />Yes No ? <br />5°C On Ice <br />Yes ? No ? No VOA vials submitted 0 <br />Yes 0 <br />--------------- No ? <br />-------------- Not Applicable ? <br />----------------------------- <br />Page 29 of 39